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Wednesday, June 19, 2013
Urinary and Genital Disorders (Children)
Bi-Lateral Kidney Reflux in Male Infant
My 10 week old son has been diagnosed with grade 3 kidney reflux on both sides (he was hospitalized for 3 days with a UTI).
1. What is the likelihood that he will outgrow the condition altogether? 2. What is the youngest age he can have the standard surgery? 3. By what age will surgery be recommended if he hasn`t outgrown the problem? 4. The urologist recommends an ultrasound every 6 mos. and antibiotic therapy. He does not want to repeat the VCUG until the baby is potty trained. He also will not order a urine culture unless another UTI is suspected. Should I seek a second opinion? 5. The baby does not seem to be tolerating the medicine well. He is having excessive diarrhea (about 5x/day) and is very tired. Should I be concerned?
The likelihood of reflux resolution is approximately 50% over time. However, in boys, grade II reflux usually is not problematic. UTIs are much more common in boys who are uncircumcised.
Infants (less than 1 year old) can undergo either open (standard) antireflux surgery or endoscopic injection with Deflux. However, unless there is another UTI, it does not need to be performed. There is no standard age for recommending surgery, but the average age for reflux resolution is 6-7 years. An US in 6 months and antibiotic prophylaxis is reasonable management. I usually get a follow-up VCUG at 18-24 months. If the reflux is resolved or signficantly improved, then the prophylaxis can be discontinued. I would not recommend obtaining a routine urine culture unless a UTI is suspected.
I do not think you need a second opinion. The medication issue is common. Trimethoprim/sulfa usually does not cause diarrhea. One option is Macrodantin (nitrofurantoin capsule). The powder can be put in the bottle or food and is tolerated well. The nitrofurantoin liquid is tolerated very poorly.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University